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(1)There is a fine line here between improving the quality of referrals and the ideology of throwing a patient forward and backward . Under the current ‘toxic’ working conditions of GPs , the latter certainly will add another caveat to the narrative of general practice being unsafe(the upper limit of how many patients a GP should see daily , prescribing mistakes, opiods/gabapentinoids etc).
(2) Once referral management(RM)becomes the ‘social norm’ in NHS , it is a no-return road . More robust RM will feed the political narrative/incentive of cutting further resources in secondary care (or even closing more hospitals while I would argue we actually need more hospitals).
(3) It is also about transferring responsibility from A to B and back to A like a boomerang. I would argue that the RM doctor should personally pass the referral to an alternative clinician(e.g. GPSI) other than specialists in secondary care if he/she deems necessary. If a simple treatment is indicated, he/she should initiate the prescribing for the patient. And if he/she thinks there is no indication to have any specialist opinion(e.g. treatment not covered by NHS),he/she will send a letter of explanation to the patient.
Yes , do not judge the book by the cover but the judgement also does not sustain without properly balancing the benefits and risks , and more importantly, analysing the current political circumstances .
Ultimately, deep down ,we all know where the root of the culpability lies for these’ circumstances’ we are under .

That is exactly why we need to pursuit (or spin , in the name of gaming) the narrative of upper , safe limits of how many patients a GP can see everyday, alongside with limits on other workload, even though we all know NHSE and DHSC will immediately say NO.

I think one should mix the issues of the role of telemedicine and a cherry picking business together. I will have an open mind for the former but what actually had pis**d off people was the fact the latter was rewarded with the same remuneration as conventional general practice.
I see no difference for private hospitals stealing ‘easier’ procedures from NHS hospitals with all kinds of exclusion criteria( the fixed tariff system).
Another duplicity from this irresponsible government and its health secretary.

He told The Telegraph: “Doctors see things that many other people will never see in a lifetime. Just as when soldiers go to Afghanistan, you don’t want the first time they see at somebody who has suffered terrible injuries to be when they’re dealing with an emergency in the heat of the moment.

“We need to try and prepare them for that in advance,” he said.

“Army personnel have told me that they would not begin resilience training just as they’re about to deploy and I fully understand that. The army discovered some time ago that soldiers under pressure aren’t helped if they are just told to keep a stiff upper lip. It’s time medicine reached a similar conclusion – and acted on it.''

So we see things people will never see in a lifetime and that includes the way being treated by our regulator(s)?

He told The Telegraph: “Doctors see things that many other people will never see in a lifetime. Just as when soldiers go to Afghanistan, you don’t want the first time they see at somebody who has suffered terrible injuries to be when they’re dealing with an emergency in the heat of the moment.

“We need to try and prepare them for that in advance,” he said.

“Army personnel have told me that they would not begin resilience training just as they’re about to deploy and I fully understand that. The army discovered some time ago that soldiers under pressure aren’t helped if they are just told to keep a stiff upper lip. It’s time medicine reached a similar conclusion – and acted on it.''

Ladies and gentlemen, what Prof TS said could easily reflect his own opinion (in the manner this interview was conducted) , and hence, does not necessarily represent the official announcement from the almighty GMC .

Ladies and gentlemen, what Prof TS said could easily reflect his own opinion (in the manner this interview was conducted) , and hence, does not necessarily represent the official announcement from the almighty GMC .

This is how the world is going at the moment. Because of all the anger and discontent towards establishments, populism rises . Populism is a phenomenon and bears certain moral argument , whether one likes it or not . If the establishment insists its way resisting drastic changes ,it faces the real threat of extinction. History has provided that lesson repeatedly.This is an uproar and outcry at the right time and right place. Those who choose to defend the indefensible should be so ashamed of themselves.Let’s hear the voices of the rebels.......

Divided we fall: the commodification of primary medical care(3.3.2018 BMJ)http://www.bmj.com/content/360/bmj.k787The current controversy on GP at Hand service demonstrates the ideology of cherry picking as well as utilitarianism. Successive policies of this government simply pushed for more prettier numerical figures while continuing to starve general practice of resources it needs.We have a code and morality to serve not a bunch of statistical icons favourable for the government and its health secretary to deliver their clandestine agenda(s).

‘’Is morality a matter of counting lives and weighting costs and benefits , or are certain moral and human rights are so fundamental that they rise above such calculations?’’JusticeMichael J Sandel

Take your point the document is not clear cut and dare enough. Clearly , this demonstrates the potential fear and paranoia of NOT being politically correct in all these medical establishments without examining properly the political circumstances as we are up against this irresponsible government. This clearly explains the immediate feeble response from the chair of RCGP.But as I wrote last two days, it is strategic for us to open narrative(s) like ‘NHSE ignores patients’ safety’. Thanks to Pulse, we can certainly spin more with this . No surprise NHSE said ‘NO’ and used a human tape recorder to playback the typical response that the government already had invested so many billions in primary care .And Sara , RESPOND if you still have a conscience calling yourself a general practitioner.

‘’It seems yet another BMA policy document may not be worth the paper it is written on.’’

Disagree totally . Although you can criticise me of having some ‘baggages’ on BMA and GPC , this move at this right moment is entirely strategic in terms fighting our battle is concerned. Nobody expects NHSE and DHSC to agree (in fact , I would be even more worried if they said so called ‘Yes’). We need a strong narrative to blow a small hole in the enemy’s defence line and keep drilling. The only disappointment is the ‘mighty’ and politically correct RCGP failed to see this in terms of playing game of politics.If our enemy chose to face in public the soundbite ‘ you ignore the safety of patients’ (of course , we need to spin this), we had moved a small step forward .

PeterRespect any decision you made.Truth is in critical times , voices are what we need . If I am correct , I have been writing on this platform for nearly ten years and saw people coming and going . My own style of writing have changed quite substantially as well . Previous editor of Pulse was accommodating on all opinions and so is Nigel . But as the reputation grew , the pressure of trying to control polarised views(and even defamatory) also increased. Under the evolution of internet, journalism has changed to almost ‘unrecognisable’ compared with twenty years ago because everyone can become a content provider as well as fancying being the key opinion leader(KOL). Shame . Another aspect is having an open platform (not so much these days here as you have to be a registered practitioner) , one would not know what one’s ‘real intentions’ are on ‘infiltrating’ this platform. I am not surprised that many politicians were ‘monitoring’ Pulse these days.My advice is only do the things you still believe , walk away if you don’t. No hard feelings. Life is short and many other things matter .For stupid me , I still believe in freedom of speech but more importantly, freedom from fear. If newspaper was labelled as the ‘Fourth Estate’ (or Fourth Power) , platform like this , together with social media , is the new ‘Fifth Estate/Power’ but with its merits and pitfalls.

Not going to write any more.The difference between knowing the game of politics and NOT . But would not be surprised from somebody trying to be politically correct. There were some concrete reasons why Hilary Clinton could never win the presidency......